Morphometry of the sural nerve in diabetic neuropathy: a systematic review.

PURPOSE: The aim of this systematic review is to evaluate the usefulness of sural nerve ultrasonography in diagnosing diabetes mellitus (DM) and diabetic polyneuropathy (DPN), the latter of which is a common long-term complication for diabetic patients that frequently involves the sural nerve. METHODOLOGY: A meta-analysis of the cross-sectional areas (CSAs) of sural nerves in healthy individuals and patients with diabetes mellitus based on a total of 32 ultrasonographic-based studies from 2015 to 2023 was performed. Sub-analyses were performed for factors such as geographical location and measurement site. RESULTS: The meta-analysis showed that the mean CSA of the sural nerve was significantly larger in DM patients with DPN only compared to healthy individuals across all regions and when pooled together. An age-dependent increase in the CSA of healthy sural nerves is apparent when comparing the paediatric population with adults. CONCLUSION: Sural nerve ultrasonography can distinguish diabetic adults with DPN from healthy adults based on cross-sectional area measurement. Future studies are needed to clarify the relationships between other parameters, such as body metrics and age, with sural nerve CSAs. Cut-offs for DPN likely need to be specific for different geographical regions.

Perceived effectiveness of an innovative mobile-based serious game on the improvement of soft skills in minimally invasive surgical training.

INTRODUCTION: Soft skills have a pertinent role for the quality and efficient outcomes in minimally invasive surgical procedures that are difficult to practice due to time constraints, limited resources, and other logistical reasons. The literature says that serious games serve as better resources for learning soft skills but needs evaluation from stakeholders. This study explores the perceived effectiveness of serious gaming intervention as a learning tool to improve communication, collaborative skills among the residents in surgery, house officers and junior doctors. METHOD: A total of nine participants volunteered to take part in the exploratory study. During the study, the participants responded to a pre-test quiz, followed by exploration of the game and a post-test quiz. The perceived perceptions on the effectiveness of the gaming intervention were collected on a five-point Likert scale questionnaire with open-ended questions. RESULTS: There was no significant difference in pre-test and post-test scores on communication and collaborative skills. Among the three themes, there was significant effect of usefulness of the application of improvement of soft skills (90% response); however, technicalities should be addressed (50% of responses). The qualitative feedback renders that, better graphics, tutorial run, user-friendly interface and controls, and enhanced 3D environment would enhance the efficacy of the prototype. CONCLUSION: An innovative mobile-based serious gaming intervention was developed and tested for its effectiveness as a resource to develop soft skills among surgeons in training. The results indicate that gamified interventions can serve as educational resources and supplement the self-directed learning in surgical education.

The Use of Mobile Games in the Management of Patients With Attention Deficit Hyperactive Disorder: A Scoping Review.

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with significant morbidity. Current treatment approaches consist of a mixture of pharmacological and psychological approaches. The emergence of digital technology, and mobile gaming applications, represents a promising novel method in potentially augmenting existing interventions for ADHD. In this review, we will map out the use of mobile gaming applications in the management of ADHD and evaluate the effectiveness of these technologies and any areas for future research. Four electronic databases were searched for relevant articles. All articles were screened for abstract and full text by two independent reviewers, and data extracted onto a common data extraction sheet. The data was narratively synthesized and reported in line with the PRISMA-ScR guidelines. A total of 19 studies were included. Studies mostly evaluated the effectiveness of games on male children with ADHD. Most games were focused on the treatment of ADHD, while a minority were focused on the diagnosis and monitoring of ADHD. Some of the common gaming mechanisms employed in games included having participants responding to cures, remembering details, and making associations between different entities. The studies generally showed an improvement in performance of children as they played the games, but evidence for the effectiveness of these modalities remains scarce and mixed. While it is exciting that there is such a wide variety of games available currently in the diagnosis, treatment, and monitoring of ADHD, many of the games lack clinical evidence to prove their effectiveness. Furthermore, most studies contain several limitations including small sample size, limited ages of participants, lack of control group, and lack of comprehensive outcomes. To promote the application of these games to clinical practice, robust clinical trials, collaboration between stakeholders and using a comprehensive set of outcome measurements is essential.

Serious games as rehabilitation tools in neurological conditions: A comprehensive review.

BACKGROUND: The use of serious games (SG) in rehabilitation has been on the rise in recent years and they are used as either a main interventional tool, or as an adjunct alongside conventional therapies. This is largely due to its virtue of being an electronic platform hence possessing game characteristics that facilitates patient progress. OBJECTIVE: The present study aimed to provide a comprehensive review of the impact of SG on neurorehabilitation therapies as well as patients' perspectives on rehabilitation. METHODS: The literature search was conducted in PubMed and Cochrane databases. The study was conducted in four different phases, consisting of the generation of MeSH terms and keywords, screening of articles, and data analysis based on the study characteristics. RESULTS: This review included 47 studies that explored the use of custom designed experimental serious games (ESG) or commercially designed serious games (CSG) for rehabilitation in a few neurological conditions. The majority of CSG used Nintendo Wii as an adjunct to conventional therapies. Significant improvement in the primary outcomes such as motor functioning, balance, executive and cognitive functions were reported in 35 studies. 17 studies also indicated patient perspectives on rehabilitation. There was no difference between the overall impact of either CSG or ESG. CONCLUSION: Evidently, SG are efficient exergame tools. However, future studies should explore patient perspectives that could help to design evidence-based games for rehabilitation purposes.

Emotional Bias Modification for Individuals With Attention Deficit Hyperactivity Disorder: Protocol for a Co-Design Study.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a worldwide prevalence rate of 5%. Individuals with ADHD often tend to have difficulties with emotional regulation. The advances in experimental psychology have led to the discovery of emotional biases. Targeting emotional biases could potentially help improve the core symptoms of irritability and short-temperedness among these individuals. Emotional biases refer to the preferential allocation of attention toward emotional stimuli. A recent study reported the presence of emotional biases among individuals with ADHD when they compared individuals with ADHD with those without. Gamification technologies have been explored to help diminish the repetitiveness of the task and increase the intrinsic motivation to train. These inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals. OBJECTIVE: The aim of this research study is to collate health care professionals' perspectives on the limitations of the existing task, and to determine if gamification elements could be incorporated, to refine the conventional intervention. METHODS: A qualitative research approach, that of a focus group, will be used. Health care professionals from the Department of Development Psychiatry, Institute of Mental Health, Singapore will be invited to participate in this qualitative research. During the focus group, participants are to comment on the limitations of the existing emotional bias intervention; recommend strategies to improve the intervention; and provide their perspectives pertaining to the use of gamification to improve the intervention. RESULTS: We expect that the study will be completed in 12 months from the publication of this protocol. CONCLUSIONS: To our best knowledge, this is perhaps one of the only few studies that have attempted to explore emotional biases among adolescents with ADHD. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/24078.

Emotional Bias Modification in Youths with Attention Deficit Hyperactivity Disorder (ADHD): New Research Vista.

Whilst cognitive bias modification was initially used in the treatment of anxiety disorders, it is also currently being used for the treatment of other psychopathologies. In fact, cognitive bias modification has been especially well-investigated amongst children and adolescents. A recent review suggests some evidence for the modification of interpretative biases amongst children with neurodevelopment disorders. There have since been other studies reporting of the existence of other cognitive biases, such as emotional biases, amongst individuals with attention deficit hyperactivity disorder (ADHD). This perspective article will discuss the epidemiology of ADHD and the nature of emotional biases that are present amongst individuals with ADHD. This perspective article also reviewed some of the studies that have assessed and modified emotional biases in individuals with ADHD. A total of three studies have been identified from the published literature that provide evidence for targeting emotional biases amongst individuals with ADHD. These studies provide us with preliminary evidence for the effectiveness of modifying emotional biases and how it could help in ameliorating symptoms related to emotional dysregulation. There needs to be future research in this area with further evidence supporting the effectiveness of modifying emotional biases. It is also crucial for future research to determine which of these tools is best at detecting such biases, and which of these tools are versatile enough and non-invasive that they could safely be implemented for both research and clinical needs.

Scan and Learn: Quick Response Code Enabled Museum for Mobile Learning of Anatomy and Pathology.

In the past, medical museums played a significant role in anatomy and pathology training. The attraction of medical museums has declined recently due to the emergence of information technology and innovative medical curricula. An innovative mobile learning platform has been developed using quick response (QR) codes for the museum specimens at the Lee Kong Chain School of Medicine, Singapore. High-quality images of the potted specimens were captured and combined into an album and a video using Adobe Acrobat Pro 9 and Windows Movie Maker, respectively. Subsequently, QR codes were generated linking to PDF documents with annotations, pathology, and clinical history concerning the specimens. Quick response codes were piloted in gastrointestinal teaching module for Year 2 medical students. Survey responses were obtained from students to verify the efficacy of QR as a learning tool. The majority of students either agreed or strongly agreed that it was easy to access the information about the specimen with QR codes (4.47 ± 0.84), while 96% of students agreed that they are able to correlate the specimen with the annotated images (4.56 ± 0.56). The majority of students (78%) agreed that QR codes are useful for their learning (4.22 ± 0.87), while 75% of students felt QR codes motivate them to visit Anatomy Resource Centre. Most of the students agreed that QR codes are useful for revision of materials (4.13 ± 1.07) and independent learning (4.38 ± 0.87). These findings suggest that QR codes are not only effective for students learning but also enhance their exploration experience with the museum specimens.

Association of parental origin with clinical profile in klinefelter syndrome.

INTRODUCTION: Several genomic imprinting mechanisms have been postulated to report the parent-of-origin in Klinefelter syndrome. It was stated in the literature, parental origin has an effect on behavioral phenotype of Klinefelter individuals, but the association of the same on clinical profile was less reported. The detailed clinical phenotype when studied with the known origin of extra X may possibly explain the imprinting effect that may be helpful to derive diagnostic criteria in the syndrome. In the present study, we investigated the parental-of-origin of extra X chromosome in Klinefelter syndrome probands with an aim to report the association between the phenotype with that of its karyotype and the parental origin of supernumerary X. MATERIALS AND METHODS: Seventy two probands that were referred to division of Human Genetics, St.John's Medical College, Bangalore with variable complaints and phenotypic features were diagnosed with informed consent as Klinefelter syndrome with a confirmed karyotype. The Karyotype was prepared by peripheral lymphocyte culture and GTG banding method. The parental origin was studied in 9 families of Klinefelter probands with standard protocol for GENE SCAN using X-chromosome specific Short Tandem Repeat markers. The outcome was analyzed to determine the parental origin by GENE MAPPER. STATISTICAL ANALYSIS: STATISTICAL ANALYSIS was conducted to ascertain the significance of parental origin of supernumerary X with the phenotypic profile with confirmed karyotype. RESULTS: Seven of nine probands had 47, XXY karyotype and 2 were mosaic with 47,XXY/46,XY karyotype. Five probands had their supernumerary X from maternal side and four were paternally derived. Sixteen features as framed proforma were tabulated against the originated X in Klinefelter probands. 55.56% of Klinefelter stigmata were seen in prob and who had maternally derived X and the rest were with paternal X. CONCLUSION: The findings of the present study points on parent-of-origin effect on clinical profile and indicate that the imprinted X chromosome genes show differential effect general and systemic traits.